All Title Author
Keywords Abstract

PLOS ONE  2012 

Cognitive Dysfunction among HIV Positive and HIV Negative Patients with Psychosis in Uganda

DOI: 10.1371/journal.pone.0044415

Full-Text   Cite this paper   Add to My Lib

Abstract:

Background Cognitive impairment is an established phenomenon in HIV infected individuals and patients that have psychosis. However there is need to establish the severity of the impairment if patients are co morbid with both conditions. Aim To compare cognitive function among HIV positive individuals and HIV negative individuals with psychosis. Methods We recruited patients with psychosis at two national referral hospitals. A standardized demographics questionnaire and psychiatric, physical, and laboratory assessments were conducted. Types of psychosis were diagnosed using the Mini International Neuropsychiatric Inventory-PLUS while cognitive functioning was determined using the Mini mental state examination (MMSE) and a neuropsychological test battery. Follow-up assessments on cognitive function and severity of psychiatric illness were performed at 3 and 6 months. Pairwise comparison and multivariable logistic regression analysis were used to determine the differences between the HIV positive and HIV negative individuals. Results There were 156 HIV positive and 322 HIV negative participants. The mean age was 33 years for the HIV positive group and 29 years for the HIV negative group (p<0.001). The HIV positive individuals were almost three times (OR = 2.62 CI 95% 1.69–4.06) more likely to be cognitively impaired on the MMSE as well as the following cognitive tests:- WHO-UCLA Auditory Verbal Learning Test (OR 1.79, 95% CI 1.09–2.92), Verbal Fluency (OR 3.42, 95% CI 2.24–5.24), Color Trails 1 (OR 2.03, 95% CI 1.29–3.02) and Color Trails 2 (OR 3.50 95% 2.00–6.10) all p = 0.01. There was improvement in cognitive function at follow up; however the impairment remained higher for the HIV positive group (p<0.001). Conclusion Cognitive impairment in psychosis was worsened by HIV infection. Care plans to minimize the effect of this impairment should be structured for the management of individuals with HIV and psychosis.

References

[1]  Goldberg TE, Berman KF, Weinberger DR (1995) Neuropsychology and neurophysiology of schizophrenia. Current Opinion in Psychiatry 8: 34–40.
[2]  Fitzgerald D, Lucas S, Redoblado MA, Winter V, Brennan J, et al. (2004) Cognitive functioning in young people with first episode psychosis: Relationship to diagnosis and clinical characteristics. Aust N Z J Psychiatry 38: 501–510.
[3]  Hori H, Noguchi H, Hashimoto R, Nakabayashi T, Omori M, et al. (2006) Antipsychotic medication and cognitive function in schizophrenia. Shizophr Res 86: 138–146.
[4]  Schmand B, Kuipers T, Van der Gaag M, Bosveld J, Bulthuis, et al (1993) Cognitive disorders and negative symptoms as correlates of motivational deficits in psychotic patients. Psychological Medicine 24: 869–884.
[5]  Bora E, Yüce M, Pantelis C (2010) Cognitive Impairment in Schizophrenia and Affective Psychoses: Implications for DSM-V Criteria and Beyond. Schizophr Bull 36: 36–42.
[6]  Sewell DD, Jeste DV, Atkinson JH, Heaton RH, Hesselink JR, et al. (1994) HIV associated psychosis: a study of 20 cases. Am J of Psychiatry 151: 237–242.
[7]  Nakimuli-Mpungu E, Musisi S, Mpungu SK, Katabira E (2006) Primary mania versus HIV-related secondary mania in Uganda. Am J Psychiatry 163: 1349–1354; quiz 1480.
[8]  Starace F, Bartoli L, Aloisi M, Antinori A, Narciso P, et al. (2002) Cognitive and affective disorders associated to HIV infection in the HAART era: findings from the NeuroICONA study. Cognitive impairment and depression in HIV/AIDS. The NeuroICONA study. Acta Psychiatr Scand 106: 20–26.
[9]  Sacktor N, Nakasujja N, Skolasky R, Robertson K, Wong M, et al. (2006) Antiretroviral therapy improves cognitive impairment in HIV+ individuals in sub-Saharan Africa. Neurology 67: 311–314.
[10]  Nath A, Schiess N, Venkatesan A, Rumbaugh J, Sacktor N, et al. (2008) Evolution of HIV dementia with HIV infection. International Review of Psychiatry 20: 25–31.
[11]  Wong MH, Robertson K, Nakasujja N, Skolasky R, Musisi S, et al. (2007) Frequency of and risk factors for HIV dementia in an HIV clinic in sub-Saharan Africa. Neurology 68: 350–355.
[12]  Robertson K, Smurzynski M, Parsons TD, Wu K, Bosch R, et al. (2007) The prevalence and incidence of neurocognitive impairment in the HAART era AIDS. 21: 1915–1921.
[13]  Heaton RK, Clifford DB, Franklin DR Jr, Woods SP, Ake C, et al. (2010) HIV-associated neurocognitive disorders persist in the era of potent antiretroviral therapy: CHARTER Study. Neurology 75: 2087–2096.
[14]  Kapiriri L, Sofaer N, Atuyambe L, Otolok-Tanga E, Norheim OF (2009) Criteria used for selecting patients for antiretroviral therapy in Uganda: A qualitative study. Journal of AIDS and HIV Research 1 034–043.
[15]  Shapshak P, Kangueane P, Fujimura RK, Commins D, Chiappelli F, et al. (2011) Editorial NeuroAIDS review. AIDS 25: 123.
[16]  Sheehan D, Lecrubier Y, Sheehan K, Amorim P, Janavs J, et al. (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59: 22–33.
[17]  Young R, Biggs J, Ziegler V, Meyer D (1978) A rating scale for mania: reliability, validity, and sensitivity. Br J Psychiatry 133: 429–435.
[18]  Overall J, Gorham D (1962) The brief psychiatric rating scale. Psychological Reports 10: 799–812.
[19]  Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 16: 606–613.
[20]  Sacktor NC, Wong M, Nakasujja N, Skolasky RL, Selnes OA, et al. (2005) The International HIV Dementia Scale: a new rapid screening test for HIV dementia. Aids 19: 1367–1374.
[21]  Robertson KR, Nakasujja N, Wong M, Musisi S, Katabira E, et al. (2007) Pattern of neuropsychological performance among HIV positive patients in Uganda. BMC Neurol 7: 8.
[22]  Folstein MF, Folstein SE, McHugh PR (1975) “Mini-Mental State”: A Practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12: 189–198.
[23]  Hill K, Reilly J, Harris M, Rosen C, Marvin R, et al. (2009 ) A comparison of neuropsychological dysfunction in first-episode psychosis patients with unipolar depression, bipolar disorder, and schizophrenia. Schizophrenia Research 113: 167–175.
[24]  Maling S, Todd J, Van der Paal L, Grosskurth H, Kinyanda E (2011) HIV-1 seroprevalence and risk factors for HIV infection among first-time psychiatric admissions in Uganda. AIDS Care 23: 171–178.
[25]  Iacono W, Beiser M (1992) Are males more likely than females to develop schizophrenia? Am J Psychiatry 149: 1070–1074.
[26]  McArthur JC (2004) HIV dementia: an evolving disease. J Neuroimmunol 157: 3–10.
[27]  Kipp W, Alibhai A, Saunders L, Senthilselvan A, Kaler A, et al. (2010) Gender differences in antiretroviral treatment outcomes of HIV patients in rural Uganda. AIDS Care-Psychological and socio-medical aspects of AIDS/HIV 22: 271–278.
[28]  Baran H, Hainfellner JA, Kepplinger B, Mazal PR, Schmid H, et al. (2000) Kynurenic acid metabolism in the brain of HIV-1 infected patients. J Neural Transm 107: 1127–1138.
[29]  Atlas A, Gisslen M, Nordin C, Lindstrom L, Schweiler L (2007) Acute psychotic symptoms in HIV-1 infected patients are associated with increased levels of kynurenic acid in cerebrospinal fluid. Brain Behav Immun 21: 86–91.
[30]  el-Mallakh RS (1992) HIV-related psychosis. J Clin Psychiatry 53: 293–294.
[31]  Horwah E (2002) Psychiatric and neuropsychiatric manifestations of HIV infection. Journal of the International Association of Physicians in AIDS Care 1: S4–S15.
[32]  Dolder CR, Patterson TL, Jeste PT (2004) HIV Psychosis and ageing: past, present and future. AIDS 18: 35–82.
[33]  Dubé B, Benoit T, Cruess DG, Evans DL (2005) Neuropsychiatric manifestations of HIV infection and AIDS. J Psychiatry Neurosci 30: 237–246.
[34]  Nilsson L, Linderholm K, Engberg G, Paulson L, Blennow K, et al. (2005) Elevated levels of kynurenic acid in the cerebrospinal fluid of male patients with schizophrenia. Schizophr Res 80: 315–322.
[35]  Nakimuli-Mpungu E, Musisi S, Kiwuwa S, Katabira E (2008) Early-Onset Versus Late-Onset HIV-Related Secondary Mania in Uganda. Psychosomatics 49: 530–534.
[36]  Sacktor N, Skolasky RL, Lyles RH, Esposito D, Selnes OA, et al. (2000) Improvement in HIV-associated motor slowing after antiretroviral therapy including protease inhibitors. Journal of Neurovirology 6: 84–88.
[37]  De Ronchi D, Faranca I, Forti P, Ravagalia G, Borderi M, et al. (2000) Development of acute psychotic disorders in HIV infection. International Journal of Psychiatry and Medicine 30: 173–183.

Full-Text

comments powered by Disqus